USACHPPM HEALTH INFORMATION OPERATIONS (HIO) UPDATE 25 July 2003

The HIO Update provides information regarding global medical and veterinary issues of interest to the United States (US) Army. The update does not attempt to analyze the information regarding potential strategic or tactical impact to the US Army and as such, should not be regarded as a medical intelligence product. Medical intelligence products are available at http://mic.afmic.detrick.army.mil/. The information in the HIO Update should provide an increased awareness of current and emerging health-related issues.

HOT TOPICS................................................................................................ 2
Anthrax Bug Blocks Immune System ....................................................................................................... 2 Aspirin Could Reduce the Risk of Deadly Infections.............................................................................. 2 Fish, Nuts May Ward off Alzheimer’s ....................................................................................................... 2 Health Warning on Tattoo Chemicals....................................................................................................... 3 High-Dose Birth Control Pill Safe for Women — Unless They Smoke................................................ 3 Hospital Superbugs Spread to Visitors..................................................................................................... 3 Knee Taping Reduces Symptoms Associated with Osteoarthritis ....................................................... 3 Satellites Will Join Search for Source of Ebola Virus............................................................................. 4 Transplant Patients Linked to SARS Spread .......................................................................................... 4 West Nile Virus Causes Paralysis in Some ............................................................................................. 4

USEUCOM.................................................................................................... 4
Angola: Optimism About Poliomyelitis Eradication By 2005................................................................ 4 Cholera in Liberia - Update ........................................................................................................................ 5 Kazakh Anthrax Linked to Horse Meat..................................................................................................... 5 Russia: Crimean-Congo Hemorrhagic Fever Outbreak in Stavropol Region..................................... 5 West Nile Virus Found in Birds .................................................................................................................. 5 Zimbabwe: Fresh Outbreak of Foot-And-Mouth Deals Blow to Livestock Industry.......................... 6

USCENTCOM............................................................................................... 6
Diphtheria Kills Three Afghan Refugee Children .................................................................................... 6 Kenya: Thousands of Refugees in Danger From Floodwater ............................................................. 6 Red Cross Warns Sudan Drought Reaching Critical Point ................................................................... 6

USNORTHCOM ........................................................................................... 7
EPA Hopes to Cut Waterborne Cryptosporidium Infections ................................................................. 7 Food Scientists to Assess Bioterrorism Risk........................................................................................... 7 HIV Prevention Guidelines Issued ............................................................................................................ 7 Illinois: First Confirmed Human Case of Eastern Equine Encephalitis................................................ 7 Patients Find Answers about Lab Tests at Lab Tests Online ............................................................... 8 Updated Interim Infection Control and Exposure Management Guidance in the Health-Care and Community Setting for Patients with Possible Monkeypox Virus Infection......................................... 8 U.S. Army Awards Researcher $1 Million Grant to Develop Tularemia Vaccine .............................. 8 West Nile Virus 2003 Human Cases as of July 21, 2003...................................................................... 9

USPACOM.................................................................................................... 9
Cambodia: Increased Frequency of Dengue Virus Type 4 Infection in Children............................... 9 China: 74 Cases of Rabies Reported in Guangdong Province ............................................................ 9 Cholera Outbreak in India......................................................................................................................... 10 Encephalitis Death Toll Rises to 140 in Southern India....................................................................... 10 Hong Kong: 20 Imported Cases of Dengue........................................................................................... 10

India: Dengue Fever Outbreak Continues Unabated in Kerala .......................................................... 10 Indonesia: Dengue Fever Kills 26 in West Java ................................................................................... 10 Japan: Transmission of Hepatitis B Virus Via Blood Transfusion ...................................................... 11 Philippines: Malaria Kills 87 in Nueva Vizcaya, Igugao Province....................................................... 11 Singapore and Indonesia Join Hands to Keep ASEAN SARS-Free.................................................. 11 Singapore Establishes Chemical Response Unit ................................................................................. 12 Vietnam: More than 9000 Dengue Fever Cases with 22 Deaths ....................................................... 12

USSOUTHCOM ......................................................................................... 12
American Officials Launch Bush's AIDS Initiative in Haiti ................................................................... 12 Panama: Case of Hantavirus Infection Reported in Los Santos Province ....................................... 12 Thousands Flee Venezuela Floods ........................................................................................................ 12

HOT TOPICS
Anthrax Bug Blocks Immune System
16 July – CBS News reported that anthrax swiftly disarms the sentinels of the body's immune system, hampering their ability to defend against the potentially lethal bioterrorism agent, a new federal study shows. The results suggest medical treatment to boost the immune system at the earliest stages of infection could counteract the toxin that anthrax produces in its initial attack. Antibiotics, like Cipro, could be used in concert to kill the bacteria themselves. In the new study using mice, researchers at Emory University in Atlanta, the Centers for Disease Control and Prevention and the National Institutes of Health, provide some fundamental answers: They found that anthrax toxin targets frontline immune agents called dendritic cells. Once the bacteria disarm the dendritic cells, they can evade the immune system's other defenders and spread unchecked. Details appear in this week's issue of the journal Nature. View Article

Aspirin Could Reduce the Risk of Deadly Infections
15 July – Science Blog reported adding to the long list of the benefits of aspirin, researchers have found that it is responsible for reducing toxic bacteria associated with serious infections. A study led by Dartmouth Medical School describes how salicylic acid, produced when the body breaks down aspirin, disrupts the bacteria's ability to adhere to host tissue, reducing the threat of deadly infections. View Article

Fish, Nuts May Ward off Alzheimer’s
21 July — MSNBC News reported eating plenty of fish, nuts and oil-based salad dressings that contain polyunsaturated fatty acids cuts the risk of developing Alzheimer’s disease, researchers said. A seven year study of 815 nursing home residents found those who reported eating fish at least once a week had a 60 percent lower risk of Alzheimer’s compared to those who rarely or never ate fish. Researcher Martha Clare Morris of Rush-Presbyterian St. Luke’s Medical Center in Chicago, writing in The Archives of Neurology journal, credited polyunsaturated fatty acids found in fish, nuts and oily dressings for the protective effect. She said the fatty acids are also found in the membranes of brain cells, and may protect them from the ravages of Alzheimer’s. Previous studies have cited a healthy diet rich in antioxidants may stave off Alzheimer’s, though the root cause of the brain-clogging plaque that afflicts an estimated 12 million people globally remains unknown. View Article

Health Warning on Tattoo Chemicals
18 July – CNN News reported fans of tattooing are putting poisonous chemicals into their skin because of widespread ignorance about the substances used in tattooing dyes, the European Commission is warning. "Would you inject car paint into your skin?" the Commission asked in a statement accompanying its report on the health risks of tattooing and body piercing. With the fashion for body adornment growing, the Commission said too little was known about the chemical structure and toxicity of tattoos. It said most chemicals used in tattoos were industrial pigments originally used for other purposes, such as automobile paints or writing inks, and there was little or no safety data to support their use in tattoos. The report said that as well as the risk of catching diseases such as HIV, hepatitis, or bacterial infections from dirty needles, tattooing could cause skin cancer, psoriasis, toxic shock syndrome or even behavioral changes. The research was the first part of a drive to make the practices safer, a spokesman said. View Article

High-Dose Birth Control Pill Safe for Women — Unless They Smoke
17 July – ABC News reported new research has found past users of birth control pills face no additional overall risk — that is, unless they were also smokers. A study published in today's issue of the British medical journal Lancet compared mortality rates of women who used oral contraceptives, or OCPs, during the 1970s vs. those who used other forms of birth control. Although the research found a strong link between OCP use and cervical cancer, that result was balanced by the finding that OCPs were also a strong preventive measure for other uterine cancers. OCP use was not linked to breast cancer or other cancers. And while OCPs weren't shown to have a link to heart disease for nonsmokers, for those who did smoke the risk of heart disease was doubled. "The key conclusion," said lead researcher Martin Vessey, "is that in terms of overall mortality, oral contraceptives are very safe and smoking is very harmful." View Article

Hospital Superbugs Spread to Visitors
16 July – Reuters reported patients who become infected with antibiotic-resistant microbes while in the hospital often pass on the germs to visitors and other contacts. To investigate, a team headed by Dr. David P. Calfee, from the University of Virginia Health System in Charlottesville explored the origins of MRSA among 172 personal contacts of 88 patients who acquired MRSA during a hospital stay. Twenty-five of the 172 personal contacts were carriers of MRSA, the authors report, including 24 of 130 with close contact and 1 of 42 with only casual contact. DNA fingerprint patterns from MRSA specimens were identical in the contacts of 8 out of 9 patients tested, the researchers found. "This strongly supports the hypothesis that cross-transmission of a single strain between the index patient and his or her household contact(s) had occurred in each instance," the authors conclude. View Article

Knee Taping Reduces Symptoms Associated with Osteoarthritis
19 July – The British Medical Journal published a study where therapeutic tape applied to the knee significantly reduced pain caused by osteoarthritis. In a randomized controlled trial in Australia, Hinman and colleagues studied the effects of therapeutic tape, a control tape, and no tape in 87 patients aged 50 years and older with osteoarthritis of the knee. Patients allocated therapeutic tape reported the greatest reduction in pain, and benefits were maintained three weeks after treatment had stopped. The authors suggest that knee tape may reduce pain by realigning the patella and unloading painful soft tissues. They state that knee taping, as an adjunct to exercise and drug treatment for knee osteoarthritis, is a simple and inexpensive self-management strategy. View Article

Satellites Will Join Search for Source of Ebola Virus
16 July – The European Space Agency reported microscopes are not the only tools available to study disease. A new ESA project employs satellites to predict and help combat epidemic outbreaks, as well as join the hunt for the origin of the deadly Ebola virus. Ebola hemorrhagic fever kills many people in Central Africa each year. It can cause runaway internal and external bleeding in humans and also apes. What remains unidentified is the jungle-based organism serving as the virus’s host. To assist search efforts, from next year detailed vegetation maps of Congo and Gabon will be created with satellite images as part of a new ESA Data User Element project called Epidemio, developing Earth Observation (EO) services for epidemiologists. The Gabon-based International Centre for Medical Research (CIRMF) will combine EO data with field results within a geographical information system (GIS). They hope to spot particular environmental characteristics associated with infected sites where either dead animals are found or local people have acquired Ebola antibodies. View Article

Transplant Patients Linked to SARS Spread
22 July – The National Post reported their immune systems weakened by anti-rejection drugs, people who have had organ transplants seem at particular risk from SARS and are more likely to become virus "super-spreaders," reveals a new study by Canadian scientists. Two such patients in Toronto, including a lung recipient who was still recovering in hospital, contracted the disease and died after infecting numerous others, said one of the study's authors. At least one of those infected by the recipients also died. In response, hospitals have developed a new screening system they hope will prevent transplant patients from getting the virus from an infected organ if there is another outbreak of SARS. "If they are infected, they seem to have more severe disease, harder to control disease," said Dr. Deepali Kumar of Toronto's University Health Network, lead author of the paper in the American Journal of Transplantation. View Article

West Nile Virus Causes Paralysis in Some
22 July – Reuters reported polio-like paralysis and neurological symptoms such as memory loss and chronic headaches afflict some patients infected with the West Nile virus, U.S. government researchers said. The mosquito-borne virus has reappeared this year in 32 U.S. states after infecting more than 4,000 people in 20 states last year, killing 284 people. An estimated 200,000 people have been exposed to the virus, which in most healthy people produces a low-grade fever but can create serious health problems in roughly 1 percent of those infected. A study conducted in hard-hit St. Tammany Parish, Louisiana, concluded that a small portion of patients developed acute, longerlasting symptoms that included meningitis, encephalitis, and poliomyelitis-like paralysis. Some developed movement disorders that resembled the tremors of Parkinson's disease, and others suffered chronic muscle contractions. View Article

USEUCOM
Angola: Optimism About Poliomyelitis Eradication By 2005
18 July – Allafrica.com reported Angolan health authorities are optimistic about eradicating poliomyelitis from the country by 2005, a deadline set by the United Nations. The information was released in Luanda by the Coordinating team (Health Ministry, World Health Organization And UNICEF) that produced a picture of the situation in Angola. The director of the Broad Vaccination Program (PAV), Fátima Valente, said Angola has the possibility to meet the UN deadline as no case of poliomyelitis has been recorded in the country since 2001. She said as well that another reason for

optimism is that over the last few years the quality of intervention in terms of epidemiological surveillance and door-to-door routine vaccine coverage is very high. With the advent of peace, the physician said, all districts of the country will be covered by the vaccination campaigns, including those of hard road access caused by the proliferation of landmines. View Article

Cholera in Liberia - Update
15 July – WHO reported new figures for the period 30 May -29 June have been reported: 1280 cases, including 15 deaths (see previous report). With 350 new cases reported during the period 30 June- 6 July, the total of cholera cases in Monrovia is now 1630, including 15 deaths. The security situation still makes it difficult to obtain exact numbers of cases and deaths. Nongovernmental organizations, including MERLIN and Médecins sans Frontières (France and Belgium) have established diarrheal units at centers for internally displaced people in the city. WHO, with UNICEF, is working with the Ministry of Health to finalize plans to extend the mass chlorination activities to communities in Monrovia and its surrounding areas. In addition, WHO is distributing health education materials on cholera prevention and control to health facilities and communities. View Report

Kazakh Anthrax Linked to Horse Meat
21 July – ProMed reported health workers in a southern Kazakh village are trying to prevent the spread of an anthrax outbreak attributed to diseased horsemeat, an official in the Central Asian country said. "6 men have been hospitalized, of whom 3 have so far had the diagnosis confirmed," Albert Askarov, head of epidemiological control at the former Soviet Republic's health ministry said. The 6 residents of Abai village slaughtered the sick animal in early July 2003 without veterinary approval, Askarov said. The slaughter site has been disinfected and covered with concrete in order to neutralize anthrax spores, which can remain active in soil for decades, Askarov said. View Report

Russia: Crimean-Congo Hemorrhagic Fever Outbreak in Stavropol Region
18 July – ProMed reported the epidemiologic situation with regard to Crimean-Congo hemorrhagic fever in the Stavropol region of Russia is not improving. 3974 people have been bitten by ticks, which transmit the Crimean-Congo hemorrhagic fever virus. Fourteen of the people who were bitten became ill and two of those have died. Tick activity is not decreasing and active measures will be required to contain the epidemic. View Report

West Nile Virus Found in Birds
19 July - BBC News reported evidence of the potentially deadly West Nile virus has been found in a high proportion of British birds, scientists have revealed. Mosquitoes transmit the virus and researchers have warned that the risk of the virus spreading to humans is increasing with the impact of climate change. There have been no cases of the virus in the UK but it killed more than 270 people in the US last year. Scientists at the Center for Ecology and Hydrology in Oxford tested birds mainly in Cambridgeshire, but also in Dorset and South Wales. They found evidence of the virus in more than half the birds tested - an "unexpectedly high" proportion, BBC science correspondent Christine McGourty said. It was found in more than 20 species in all, including crows, magpies, swallows, chickens, turkeys and ducks. While the birds were healthy and showed no symptoms, scientists did detect antibodies to the virus. It is thought the virus is being brought into the country by migrating birds. View Article

Zimbabwe: Fresh Outbreak of Foot-And-Mouth Deals Blow to Livestock Industry
17 July – IRIN News reported Zimbabwe's livestock industry was dealt another blow this week with reports of an outbreak of foot-and-mouth disease (FMD) on two farms south of the capital, Harare. Officials told IRIN an investigation was under way to determine the source of the infection and that Mashonaland West, Mashonaland Central and Mashonaland East provinces had been put under a "movement embargo" pending the outcome. "It is still too soon to determine the source of the infection, but we suspect that it may be linked to previous outbreaks in Masvingo province," Stuart Hargreaves, director of Zimbabwe's veterinary services, told IRIN. In June an outbreak of FMD hit Chivi and Gutu districts in Masvingo, forcing the Department of Veterinary Services to suspend all movement of livestock. View Article

USCENTCOM
Diphtheria Kills Three Afghan Refugee Children
20 July – Reuters reported three Afghan children from a camp in the south of the country to which the United Nations is transferring thousands of refugees from Pakistan have died of diphtheria, U.N. officials said Sunday. Officials of the World Health Organization in Kabul said the children died on their way to a hospital in Pakistan from the camp at Zhare Dasht near the Afghan city of Kandahar. WHO spokeswoman Yvette Bivigou said a total of 17 children were affected. Six were currently being treated in the Pakistani town of Quetta, while eight were in hospital in Kandahar. WHO program officer Dr. Dorji Tsogzolmaa said emergency steps had been taken to isolate those affected and vaccinate under-fives. The WHO has also ordered two million doses of anti-toxin to prevent an outbreak of the disease. View Article

Kenya: Thousands of Refugees in Danger From Floodwater
21 July – Allafrica.com reported the lives of about 17,000 people living in the Kakuma refugee camp, northwestern Kenya, are in danger from flooding caused by the merging of two seasonal rivers, the UN warned. The two rivers, the Taraich and the Nakabet, are expected to merge during the next rainy season in October that will lead to an island in the center of the camp. The camp could then collapse. UNHCR has appealed for funding to urgently move the refugees to the north of Kakuma camp, and is currently involved in negotiations with local elders regarding the allocation of new land. View Article

Red Cross Warns Sudan Drought Reaching Critical Point
19 July – The VOA News reported the International Federation of Red Cross and Red Crescent Societies says a prolonged drought in Sudan has left hundreds-of-thousands of people suffering chronic food and water shortages, and vulnerable to malnutrition and disease. The Geneva-based agency says it has received a very poor response to its emergency appeal for $852 million. The agency says people in Sudan's Red Sea State are only just surviving. It says the situation has reached crisis point after several years of drought. United Nations agencies predict a food deficit of 60 percent for this year. View Article

USNORTHCOM
EPA Hopes to Cut Waterborne Cryptosporidium Infections
17 July – CIDRAP News reported the Environmental Protection Agency (EPA) is proposing a new requirement for water systems that it says could prevent up to a million illnesses a year by reducing Cryptosporidium contamination in drinking water. The new requirement will affect water systems that are more vulnerable than most to Cryptosporidium contamination because of higher levels in their water sources or because they use surface water without filtering it, the EPA said in a Jul 11 news release. Under the rule, called the Long Term 2 Enhanced Surface Water Treatment Rule, water systems in the higher-risk groups would have to achieve an additional 90% to 99.7% (1.0- to 2.5-log) reduction in Cryptosporidium levels, the EPA said. All unfiltered systems would have to provide at least 99% or 99.9% (2- or 3-log) inactivation of the pathogen. The regulation lists a range of treatment and management strategies that can be used to achieve the reductions. View Article

Food Scientists to Assess Bioterrorism Risk
15 July – The NY Times reported The Food and Drug Administration said it hired the Institute of Food Technologists to evaluate ways food processors can prevent or reduce the risk of deliberate contamination. The review by the industry food scientists group will look at chemical treatments, temperature controls and technology that could help protect the nation's food supply from attack, the FDA said. ‘The Institute of Food Technologists review will focus on preventive controls and research needs that might be used for eliminating or reducing the risk of an intentional act of terrorism or contamination for high and medium risk combinations of various food commodities and agents,’ the FDA said in a statement. The review, which will be kept secret, will be completed by June 2004, the FDA said. View Article

HIV Prevention Guidelines Issued
17 July – MSNBC News reported U.S. health officials called for doctors to provide HIV patients with condoms and take other measures to stem transmission of the virus that causes AIDS. New guidelines recommended by the Centers for Disease Control and Prevention and other U.S. health agencies encourage medical professionals and social workers to work more closely with people who have HIV and their partners on prevention. View Article

Illinois: First Confirmed Human Case of Eastern Equine Encephalitis
17 July – ProMed reported the state on Mon 14 Jul 2003 reported a 45-year-old Evanston woman was infected with eastern equine encephalitis virus. She became ill on 12 Jun 2003 and suffered a stiff neck and severe headache. She did not require hospital admission and has recovered. It's not known whether she was bitten in the Evanston area or in southeastern Wisconsin, where she had recently traveled. View Report Doctors caution that neither the epizootic vector Culiseta melanura nor the bridge vector species for EEE (Ochlerotatus sollicitans, Coquillettidia perturbans, and others) are susceptible to the control practices that are effective against Culex species around the household. Emptying standing water in flowerpots and rain gutters is helpful for West Nile virus, but will have no impact on the salt marsh or maple swamp species involved in EEE. EEE must be controlled with personal protection and community-scale mosquito control efforts directed at breeding sites and infected adults. View Report

Patients Find Answers about Lab Tests at Lab Tests Online
21 July – Eurekalert reported more than 200,000 people each month visit a unique website to find answers to questions regarding medical lab tests. The two-year-old website, Lab Tests Online (http://www.labtestsonline.org), provides detailed descriptions of a broad range of tests, including common tests like cholesterol and glucose. Designed exclusively to serve the patient's need for information, the noncommercial site is easily navigated, delivering explanations on why a test is performed, how it is used, and what the results might mean. View Article

Updated Interim Infection Control and Exposure Management Guidance in the Health-Care and Community Setting for Patients with Possible Monkeypox Virus Infection
18 July - The Centers for Disease Control and Prevention (CDC) and state and local health departments continue to investigate cases of monkeypox among persons who had close contact with wild or exotic mammalian pets or persons with monkeypox. Results of serologic testing, polymerasechain-reaction analysis, viral culture and gene sequencing performed at the CDC indicate that the causative agent is monkeypox virus, a member of the orthopoxvirus group of viruses. CDC is updating previous interim guidance concerning infection control precautions and exposure management in the health-care and community settings. The guidance will be further updated as additional information about the epidemiology of disease transmission is better understood. View Article

U.S. Army Awards Researcher $1 Million Grant to Develop Tularemia Vaccine
22 July - Eurekalert reported a bacteriologist in the Virginia-Maryland Regional College of Veterinary Medicine has been awarded a $1.06 million grant from the U.S. Army to develop a vaccine for tularemia. Thomas J. Inzana, the Tyler J. and Francis F. Young Professor of Bacteriology at Virginia Tech and his research team in the college's Center for Molecular Medicine and Infectious Diseases have begun a four-year program to develop a vaccine and diagnostic test for tularemia, which is commonly known as "rabbit fever." The etiologic agent of tularemia is Francisella tularensis, which the Centers For Disease Control (CDC) classifies as a Category A bioterrorism agent. The military is concerned about F. tularensis because of its heartiness and its virulence. The organism could conceivably be aerosolized and used as a bioterrorism agent at home or abroad. One aspect of F. tularensis that makes it dangerous is its ability to resist host defenses, Inzana says. Unlike many bacteria, F. tularensis has the ability to survive inside some of the front-line defenders of the body's immune system. Inzana is also working with professor of electrical and computer engineering Anbo Wang and research scientist Kristie Cooper of Virginia Tech's Center for Photonics Technology to develop photonic-based bio-sensors to detect the F. tularensis DNA in the field. Ultimately, that research could lead to the development of rapid pathogen sensing biosensors that could detect multiple pathogens on the battlefield. View Report

West Nile Virus 2003 Human Cases as of July 21, 2003
State Alabama Minnesota Ohio South Carolina Texas Total Human Cases Reported to CDC 1 1 1 1 4 8

These numbers reflect human cases that have been reported to ArboNet by state and local health departments during 2003. ArboNet is the national, electronic surveillance system established by CDC to assist states in tracking West Nile virus and other mosquito-borne viruses. View Report

USPACOM
Cambodia: Increased Frequency of Dengue Virus Type 4 Infection in Children
21 July – ProMed reported for the next 3 months, monsoons will push through Southeast Asia, drenching the region with the daily downpours that sustain this lush region. With the rains come mosquitoes. And at such places as the Angkor Hospital for Children in this northwestern Cambodian town that means combating a growing wave of dengue fever - including the potentially deadly hemorrhagic form. 7 children there are being treated for dengue. And doctors are bracing for almost 200 cases - a sharp increase over the same period last year - by the time the monsoons subside. Dengue fever, caused by 4 closely related viruses and found throughout the world's tropical zones, is spreading in Southeast Asia in ways never seen, health officials say. The disease, which is transmitted by mosquitoes that bite during the day, has begun to buck a trend of occurring in cycles of 3-5 years and shows signs of becoming an annual problem. View Report

China: 23 Cases of Dengue Fever Reported in Guangdong Province
21 July – ProMed reported South China's Guangdong Province had reported 23 cases of dengue fever as of Wed 16 Jul 2003. All of the cases were reported in Guangzhou, capital of the province. Local government and health departments have adopted a series of measures to eliminate Aedes aegypti mosquito breeding grounds and publicize methods for preventing the disease from spreading in the region. View Report

China: 74 Cases of Rabies Reported in Guangdong Province
21 July – ProMed reported at least 74 people have contracted rabies in southern China, state press and local officials reported. The Xinhua News Agency stated that the cases were reported in Guangdong Province between 5 Jan and 30 Jun 2003, adding that almost 7,000 dogs have been rounded up and killed. Governments at various levels in the province have stepped up precautionary

measures, including the organized killing of stray dogs and the immunization of local residents. An official at the Guangdong Health Department refused to give a death toll. View Report

Cholera Outbreak in India
18 July – ProMed reported a Cholera outbreak was reported in an Indian newspaper: Cholera in Northern Tamil Nadu claimed 5 lives, specifically in the Dharmapuri District 400 km west of Bombay (Mumbai). View Report

Encephalitis Death Toll Rises to 140 in Southern India
21 July – Yahoo News reported mosquito-borne encephalitis has killed more children in a southern Indian state, taking the death toll to 140, officials said. At least 257 other children have been affected across Andhra Pradesh state over the past eight weeks, Health Minister K. Sivaprasada Rao told reporters in the state capital, Hyderabad. State health official Dr. P Laxmi Rajyam said five more deaths were reported Sunday in the Warangal, Nellore, Adilabad and Medak districts. However, Rao said the situation was now under control and the number of cases was declining. The children have been killed in a rare summertime outbreak of viral meningo-encephalitis, health officials said. Most of the victims were poor, malnourished children from rural areas who may have succumbed because of a sudden change in weather from intense summer heat to monsoon rains. Many children might also have died because they could not be taken to health centers in time, experts said. The worst-affected areas are the adjoining Karimnagar and Warangal districts, where 46 and 43 deaths were reported, respectively. View Article

Hong Kong: 20 Imported Cases of Dengue
21 July – ProMed reported the number of dengue fever patients in Hong Kong hospitals in 2003 is more than 3 times what it was for the same period of 2002, but health authorities said yesterday that, so far, all were imported cases. According to the Department of Health, 20 imported cases were recorded in the first 6 months, compared with only 6 imported cases in the same period of 2002. "But this should also be a warning," medical and health officer Tsang Sam-fung said. "In the past, when we had imported cases, we also got some local ones." There were 44 cases last year, 20 of which were local. Most cases this year were of type 1 strain. View Report

India: Dengue Fever Outbreak Continues Unabated in Kerala
21 July – ProMed reported as of Sun 13 Jul 2003, the sweep of dengue fever continues unabated due a combination of ineffective vector control measures and misplaced reliance on so-called preventive drugs, according to the findings of a recent survey undertaken by the Indian Medical Association (IMA) in the city. The survey, which covered 1,040 high school students of a Government school and a `street sample' of 528 people, found that 46.9 per cent of children and 40.9 per cent of adults were affected by fever during the past 2 months. The results of the study were announced by the IMA office-holders today. Within the past 2 months, as many as 44.7 percent of the surveyed population had been infected by fever. The prevalence of fever in children (17.3 per cent) and adults (16.47 per cent) during the last week was higher than the average of 5.58 percent over the past 2 months, and this indicated that the epidemic was far from being under control. View Report

Indonesia: Dengue Fever Kills 26 in West Java
21 July – ProMed reported 26 out of 496 people affected by dengue fever in 27 sub-districts in Cirebon regency, West Java, died in the 6 months since January 2003. Herry Septjanti, a senior

official at the Cirebon health office, said the areas worst hit by the epidemic included Weru sub district, where at least 68 dengue fever cases resulted in 3 deaths. The sub districts of West Cirebon and North Cirebon were also among the worst affected areas. There were at least 62 cases of dengue fever and 3 deaths in West Cirebon, and 32 cases with one death in North Cirebon. Herry, who heads the office's disease prevention and eradication division, said the increasing number of hemorrhagic fever cases was mainly due to a lack of public awareness about how to maintain a healthy environment. In order to control the disease, he said, his office had deployed health officials to educate villagers on how to avoid being infected by dengue fever. View Report

Japan: Transmission of Hepatitis B Virus Via Blood Transfusion
21 July – ProMed reported the Japanese Red Cross Society revealed that a man had become infected with hepatitis B virus (HBV) after receiving a donation of HBV-tainted blood that had passed through its safety checks undetected. The case involves a 75-year-old man who became infected with HBV after receiving a blood transfusion in 2000 at a hospital in Nagasaki Prefecture. After the man developed the symptoms of HBV infection, the Red Cross initiated an investigation into the case. The inquiries revealed that the blood used in the transfusion had come from 8 donors, one of who was later found to have HBV, but with a viral load so low it slipped through the improved Nucleic Acid Test blood-testing system introduced in autumn 1999. The revelation raises concerns that HBV-infected blood donated by carriers with a low viral load can slip through current safety tests, opening the way for the spread of the disease. Medical experts said the Red Cross will have to review its testing system and improve its accuracy, as the donor's blood passed all of the society's tests. View Report

Philippines: Malaria Kills 87 in Nueva Vizcaya, Igugao Province
21 July – ProMed reported malaria claimed the lives of at least 87 people and infected 279 others in 13 barangays of the province. Based on a report, which covered a 6-month span from January to June 2003, the 87 deaths recorded were broken down into 40 males and 27 females. Topping the list of most affected barangays were Alfonso Castaneda with 132 cases; Diadi with 41; Quezon with 23; Bambang with 19; Bagabag with 17; Sta. Fe and Villaverde with 10 each; Aritao with 9; Dupax del Norte with 7; Solano, 5; Bayombong, 4; and Kayapa and Kasibu with one each. In Alfonso Castaneda, the lingering malaria outbreak has been blamed on the drying up of the Casecnan River owing to rampant illegal logging. The affected barangays in the town were Pelaway, Lipuga, and Cuayan, where 15 malaria-related deaths were reported. Also seriously affected, the report said, are Barangays Talbec and Abaca in Dupax del Sur. The report said the provincial health team registered a total of 33,523 consultations from ages one to 65. Of the total, 11,737 were clinically diagnosed, while 21,845 were in the outpatient category. Patients who tested positive for malaria consisted of 152 males and 127 females. The patients either contracted malaria-related diseases like infections by P. falciparum (235), P. vivax (40) and mixed infection (4). View Report

Singapore and Indonesia Join Hands to Keep ASEAN SARS-Free
22 July – Jakarta News reported Indonesia and Singapore today reaffirmed their commitment to work together to keep ASEAN SARS-free and to restore travel confidence to the region. Transport Minister Yeo Cheow Tong visited Jakarta to present four thermal scanners to Indonesian Minister of Communications, Agum Gumelar, for the screening of passengers at the Soekarno-Hatta International Airport. The four scanners will assist the Airport authorities to keep the necessary vigilance against the possible resurgence of SARS in the winter months, while making the process hassle-free and non-intrusive for passengers. They were jointly contributed by the Singapore Government and Temasek Holdings. View Article

Singapore Establishes Chemical Response Unit
17 July – NTI reported Singapore has established a unit to respond to a chemical weapons attack, Agence France-Presse reported. The Singapore Civil Defense Force Special Rescue Company now has 109 men who have undergone 10 weeks of training in special medical and rescue skills, according to AFP. The company also has six vehicles equipped with chemical agent detectors and decontamination equipment. View Article

Vietnam: More than 9000 Dengue Fever Cases with 22 Deaths
21 July – ProMed reported more than, 9000 people have been infected with dengue fever virus in Vietnam in the first 6 months of this year, a 63 percent rise over the same period in 2002. 22 people among the 9,300 struck down with the disease died. The worst affected provinces were in the southern Mekong Delta region, where moist and humid conditions provide ideal breeding grounds for mosquitoes. The region accounted for more than 92 percent of cases. View Report

USSOUTHCOM
American Officials Launch Bush's AIDS Initiative in Haiti
21 July – Yahoo News reported American officials launched President George W. Bush HIV/AIDS initiative with a mother-to-child transmission program in Haiti. The mother-to-child program is a part of Bush's proposal to spend US$15 billion over five years to help the hardest-hit African and Caribbean nations battle AIDS. He announced the initiative in his State of the Union address earlier this year. "Haiti was chosen because it is readiest to go ahead," U.S. Ambassador Brian Dean Curran said, speaking at the seaside Study Group for Sarcoma and Opportunistic Infections clinic, where the program was launched. The clinic treated more than 21,000 AIDS patients last year and has opened 25 treatment centers nationwide, where people are tested, treated, and counseled. View Article

Panama: Case of Hantavirus Infection Reported in Los Santos Province
21 July – ProMed reported the first case of hantavirus infection for 2003 was reported by the Ministry of Health (MINSA) in the foothills of Canajagua, in Las Tablas, Los Santos Province. The patient is interned in the Intensive Care Unit in the Joaquin Pablo Franco hospital in Las Tablas (assisted by a respiratory ventilator). A team from the Institution of Scientific Investigations and another from MINSA were immediately sent to the region, in order to conduct a "perifocal" study to evaluate and determine if there are other cases in family members or neighbors of the affected individual. During this study they will take blood specimens and revise the sanitary norms existing in the area. View Report

Thousands Flee Venezuela Floods
24 July – BBC News reported thousands of people have fled their homes after torrential rain and floodwaters swamped towns in southwest Venezuela. Authorities said four people were killed in the deluge after the heavy rain caused rivers to burst their banks in low-lying plains, about 375 miles south-west of the capital, Caracas. The Venezuelan military has been deployed to deliver food, water and medicine in Apure state, where waters have inundated streets and buildings in Guasdualito, near the Colombian border. View Article

Please contact the below-listed POC for suggested improvements and/or comments regarding this report. This report is also available on the USACHPPM website at http://chppmwww.apgea.army.mil/Hioupdate/. POC: Rachel Gross, PhD Rachel.Gross@APG.amedd.army.mil Lorraine Bell, DrPH, MSN Lorraine.Bell@APG.amedd.army.mil Approved: Kevin Delaney Chief, Health Information Operations (410) 436-5217 or DSN 584-5217